Research has shown that some types of bladder cancer respond well to treatment and other types are resistant, yet molecular subtyping, which can help better define a patient’s cancer and direct them to a more targeted treatment, is not performed in the clinic. This means that patients are often treated with a one-size-fits-all approach. Despite recent research progress, the movement of MIBC subtyping to the clinic has stagnated.

A group of expert pathologists recently reviewed opportunities for
MIBC subtyping and the challenges facing its adoption. Their analysis found
that a simple technique using immunohistochemistry (IHC), a traditional
antibody-based pathology method, could serve as a faster and less expensive
alternative to sequencing, while achieving the same patient selection outcomes
to guide therapy.

“We envision a
world where subtyping is efficiently and effectively deployed to ensure that
patients who will benefit from treatment get the treatment they need, while
others who may gain no benefit from treatment are spared the associated
negative side effects,” says Dr. David Berman, Director of the Queen’s Cancer
Research Institute and senior author of the review.

Since IHC is
commonplace in clinical labs, subtyping MIBC in this way could be easily
integrated into practice, meaning nearly all hospitals could perform these
tests effectively, quickly and inexpensively. Instead of looking across tens of
thousands of genes, which may cost thousands of dollars, the IHC algorithm
could use three immunostains to gain valuable information about a patient’s
cancer for a few hundred dollars. The authors also suggest that IHC-based
subtyping is a simple way to overcome the challenge of the complex mixture of
cells within bladder cancer tissue samples that often cloud sequencing analysis.

“Genome and
transcriptome sequencing has been crucial to our understanding of MIBC, but the
translation of this understanding to the clinic could be accelerated by using
simpler assays,” says Dr. John Bartlett, Program Director of Diagnostic
Development at OICR and co-author of the paper. “By using established diagnostic
assays to distinguish relevant molecular subtypes, research discoveries about
these subtypes can be used to rapidly to inform treatment selection in the
clinic.”

“The potential efficiency of an IHC-based
technique in MIBC subtyping is clear,” says Berman. “We look forward to
developing and furthering an algorithm to bring MIBC subtyping into practice.”

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